Ref Number = PITIKA-ASPR0143
Helmia Farida, MMDEAH Hapsari
Objective: Severe diphtheria is primarily marked with respiratory obstruction due to pseudomembrane, followed by cardiac complications. We reported a diphteria case with cardiac and kidney complications.
Case: A boy, 12 year-old, was referred by a Primary Health Care (PHC) because of acute tonsillitis with pseudomembrane for five days. He came from a family who rejected giving immunization to all family members.  A week before, one of his brother’s friend died because of diphtheria. In the same week, four of his six siblings also developed diphtheria with milder presentation.   At time of presentation, his tonsils were enlarged (T3-T3) covered with typical pseudomembrane, but no bull neck and respiratory symptoms appeared. Neisser staining of the throat swab resulted in positive, but no culture was positive. ECG showed bradycardia and total AV block.  He was diagnosed as intermediate diphtheria with cardiac complication, and  cared in the isolation room. He was  treated with penicillin procain, erythromycin, anti-diphtheria serum (ADS), high dose steroid, inotropics, followed by the the insertion of a temporary pace maker (TPM) on the second day of hospitalization, therefore the cardiac function was improved. On the 3rd day he developed azotemia and olyguria,  and diagnosed as the failure stage  of  acute kidney injury (AKI), therefore, a dialysis was programmed. The cardiac function was then again compromised and worsened. The patient finally passed away on the day-4 of hospitalization because of cardiogenic shock before the dialysis was performed.
Conclusions: Despite intensive treatment, the fatality rate of severe diphtheria is still high. Vaccination is the best measure to reduce morbidity and mortality caused by diphtheria. 
Keywords: severe diphteria, AKI, ADS, vaccination, bull neck
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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